Cardiology Xagena

New-onset atrial fibrillation post-surgery for esophageal and junctional cancer: strongly associated with complications, principally respiratory sepsis, and systemic inflammation

Retrospective cohort study from a prospective data base has assessed new-onset postoperative atrial fibrillation in patients with esophageal and junctional cancer.

Atrial fibrillation is common after thoracic and esophageal surgical procedures. The full spectrum of risk factors, associations, and implications are unclear.

All patients undergoing multimodal therapy or surgery with curative intent from 2006 to mid-2013 were studied. New-onset atrial fibrillation was recorded prospectively. Risk factors, management and resolution, association with other complications, and impact on in-hospital mortality and longer-term oncologic outcomes were analyzed in retrospective cohort analysis.

A total of 473 patients ( mean age: 63 years; 73% male ) underwent resection, 51% 2-stage, 18% 3-stage, 12% transhiatal, and 19% extended total gastrectomy.

Ninety-six ( 20% ) patients developed new-onset atrial fibrillation, in 18%, 27%, 29%, and 14% of 2-, 3-, transhiatal, and extended total gastrectomy cohorts, respectively ( P = 0.05 ).

Age, diabetes mellitus, neoadjuvant therapy, and cardiac history predisposed ( P less than 0.05 ) to atrial fibrillation, and atrial fibrillation was significantly ( P less than 0.0001 ) associated with pneumonia, pleural effusions requiring drainage, and maximum postoperative C-reactive protein ( CRP ) ( P less than 0.05 ) but not with anastomotic leak / conduit necrosis or mortality.

Amiodarone ( Cordarone ) was the primary treatment in 63% of cases, 1% underwent cardioversion, and 92% were in sinus rhythm on discharge.

At a median follow-up of 40 months ( 7-109 months ), the median survival was 40 months versus 53 months in the atrial fibrillation and non-atrial fibrillation cohorts, respectively ( P = 0.353 ).

In conclusion, new-onset atrial fibrillation is common, linked to age, diabetes mellitus, cardiac disease, and neoadjuvant therapy. It is strongly associated with complications, principally respiratory sepsis, and systemic inflammation.
For most, it resolves, with no impact on oncologic outcomes. ( Xagena )

Mc Cormack O et al, Ann Surg 2014;260:772-778